Provider Demographics
NPI:1164222816
Name:BENNETT, MATTHEW (RDN LD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BENNETT
Suffix:
Gender:X
Credentials:RDN LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 RIVERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-3804
Mailing Address - Country:US
Mailing Address - Phone:440-984-1508
Mailing Address - Fax:
Practice Address - Street 1:213 RIVERS EDGE DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-3804
Practice Address - Country:US
Practice Address - Phone:440-984-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10902133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered